- 期刊
Malignant Hyperthermia in Plastic Surgery
整形外科手術時的災難－惡性體溫過高症
摘要
惡性體溫過高症表現於臨床上的特徵主要為全身肌肉的僵硬，尤其是嚼肌及體溫的快速上升，並伴隨著血壓不穩定、心跳、呼吸加速、及代謝性、呼吸性酸中毒等等代謝速率增加的症狀。大多數的病患具有個人家族史，其發生率隨著地理位置、氣候及年齡及種的因素而有所差異，但發生於整形手術時的機率，目前仍沒有統計。此疾常常是因為吸入性全身麻醉藥物及去極性肌肉鬆弛劑的使用而產生。雖然此疾為一高死亡率的併發症，馬偕醫院經歷－4 歲男孩，於接受整形手術時發生此併發症，卻成功救治，且沒有任何後遺症的病例。所以我們認為隨著此疾致病機轉的更加瞭解及治療方法的進步，早期的診斷與正確的治療是可以很顯著的降低其亡率。不論病人是否有家族史，都可以在選擇性的麻醉之下很安全的接受各種整形手術。
關鍵字
無資料並列摘要
Malignant hyperthermia is characterized by hypermetabolic crisis accompanied by a rise in body temperature to as high as 40℃． It is usually triggered by potent inhalated anesthetics, depolarizing muscle relaxants and stresses. Because of the extraordinary risk of death in patients who are at risk, plastic surgeons may be reluctant to operate on these patients. We experienced a 4-year-old boy who presented with hypertrophic scar over the right knee area. The initial anesthesia was aborted for the episode of masseter muscle spasm. Malignant hyperthermia crisis developed during the second anesthesia even though the patient had no family history suggesting susceptibility to malignant hyperthermia and he had been exposed to anesthetic agents with smooth course once about one year ago. After emergency management of his crisis as outline in Table Ⅱ had been given, he recovered without sequalae. We emphasize that early recognition of the clinical features of malignant hyperthermia, whether mild or severe, is by far the most important factor in reducing mobidity and and mortality of patients who suffer hyperthermia crises while undergoing plastic surgery. Improved awareness and treatment of malignant hyperthermia can have plastic surgical procedures performed safely.